Surgical strategy for complex perineal small bowel fistula after pelvic malignancy: An etiology-driven approach

doi:10.4240/wjgs.120918

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Aug 27, 2026; 18(8): 120918
Published online Aug 27, 2026. doi: 10.4240/wjgs.120918

Table 2 Correlation between fistula etiology and surgical strategy, n (%)

Etiology	Total, n	Group 1: Reconstruction	Group 2: Plication	Dominant strategy
Empty pelvis syndrome	3	3 (100)	0 (0)	Reconstruction
Tumor recurrence	12	4 (33.3)	8 (66.7)	Plication
Radiation enteritis	9	5 (55.6)	4 (44.4)	Mixed
Surgical/iatrogenic injury	3	2 (66.7)	1 (33.3)	Reconstruction
Internal radiation: Seeds	1	1 (100)	0 (0)	Reconstruction
Total	28	15 (53.6)	13 (46.4)

Stratification of patients based on the dominant pathophysiological driver of the perineal small bowel fistula. The data illustrate strict adherence to an etiology-driven algorithm, where pure structural defects (empty pelvis syndrome) universally trigger reconstructive flap techniques, whereas recurrent, adhesive malignant disease predominantly necessitates the physiological stenting provided by intestinal plication.

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Citation: Wu TQ, Yang JF, He L, Gao RY, Wang SL, Pang BR, Wang FT, Yin L, Chen CQ, Wu XC. Surgical strategy for complex perineal small bowel fistula after pelvic malignancy: An etiology-driven approach. World J Gastrointest Surg 2026; 18(8): 120918
URL: https://www.wjgnet.com/1948-9366/full/v18/i8/120918.htm
DOI: https://dx.doi.org/10.4240/wjgs.120918

Wu TQ, Yang JF, He L, Gao RY, Wang SL, Pang BR, Wang FT, Yin L, Chen CQ, Wu XC. Surgical strategy for complex perineal small bowel fistula after pelvic malignancy: An etiology-driven approach. World J Gastrointest Surg 2026; 18(8): 120918 [DOI: 10.4240/wjgs.120918]

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